PTSD EXPRESSION OF INTEREST Step 1 of 6 - Is PADS the right program for you? 0% Are you 18 years of age or older?* Yes No Are you military/veteran or a First Responder in one of the following categories: Police, Paramedic or Fire?*We are not accepting applications from other individuals or classifications of first responders (due to funding restrictions) at this time. Yes No Do you live in one of the serviced regions?*PADS Operates our PTSD program in the Greater Vancouver, Calgary and Kelowna Areas. Yes No Are you a Canadian Citizen or Permanent Resident?* Yes No We're sorry, based on your answers you do not qualify for the PADS ProgramPlease visit Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find another school. You may also qualify for a PADS VIP (Very Important Pet). Visit pads.ca/vip for more information. About YouLegal Name* First Last Preferred First Name (If different than above) Birthdate* YYYY dash MM dash DD Gender* Male Female Prefer Not to Answer What are your pronouns? She/Her He/Him They/Them Prefer not to say Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Primary Phone*Primary Phone Type*HomeCellWorkOther PhoneOther Phone TypeHomeCellWork About your lifestylePlease describe your living situation:*For example are you in apartment, house, etc? Urban/Rural? How many/ages of family members, roommates, etc? Do you have other pets? If you have a yard is it fenced? Please describe in detail your life, work, activities, etc*Do you work outside the home, where and how often do you socialize, what kinds of activities do you participate in, hobbies, etc. Please describe your activity level*Physical activity that would include your assistance dog in future (walks, hikes, runs, bike rides, etc) Very Active (Daily Physical Activity - 1 hr or more) Active (Daily Physical Activity - Less than 1 hr) Moderately Active (Weekly Physical Activity) Less Active (Less than once per week) Are you currently in active duty/service?* Yes No Please describe how you hope a PADS PTSD Service Dog will support your independence?* Emergency ContactsPlease provide the name and contact information for two people that we can reach out to if needed (in your family, friends, support network). Person 1:* First Last Email* Phone*Relationship to Person 1* Person 2* First Last Email* Phone*Relationship to Person 2* PADS may use my contact information for the following purposes:*Please check any/all that apply Select All Regarding applying for an assistance dog With general communications from PADS (upcoming events, fundraising, eNewsletter, etc) CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
